Good prescribing starts with good information
Before we choose a medication, we look at what is happening inside your body. Labs and genetic testing take the guesswork out of treatment and keep it safe as we go.
Why we do labs
Four reasons, all about you.
Find the real cause
Low thyroid, anemia, B12 deficiency, low testosterone, blood sugar problems, and perimenopause can all create or worsen depression, anxiety, fatigue, and focus problems. Labs find these before we assume the cause is psychiatric, because treating the true cause often resolves the symptoms.
Start from a safe baseline
Many psychiatric and weight medications affect weight, blood sugar, cholesterol, the liver, the kidneys, or hormones. A baseline means we can spot small changes early instead of discovering them late.
Personalize your plan
Insulin resistance, thyroid status, vitamin levels, and hormone levels change which treatments make sense for you. Two people with the same symptoms can need very different plans once the labs are in.
Track real progress
Feelings matter most, but numbers help too. A1c, lipids, and other labs give us objective proof that the plan is working, which keeps motivation strong on the slow weeks.
The psychiatry lab panel
What we can order, what each test tells us, and why it matters for your care. Not every patient needs every test. We tailor the panel to your symptoms, history, and the medications we are considering.
| Test | Why it matters for you |
|---|---|
| Complete blood count | Screens for anemia and other blood conditions. Anemia causes fatigue and low mood that look exactly like depression, and some mood stabilizers require blood count monitoring. |
| Comprehensive metabolic panel | Checks kidney function, liver function, electrolytes, calcium, and blood sugar. Most psychiatric medications are cleared through the liver or kidneys, so we confirm those organs are healthy before starting anything. |
| TSH with reflex free T4 | Thyroid function. An underactive thyroid mimics depression and an overactive thyroid mimics anxiety. Treating the thyroid itself often resolves the symptoms, no psychiatric medication needed. |
| Hemoglobin A1c | Average blood sugar over about three months. Sets your starting point before medications that can affect blood sugar and weight, and screens for prediabetes and diabetes, which drain mood and energy on their own. |
| Fasting lipid panel | Cholesterol and triglycerides. A baseline for metabolic monitoring while on antidepressants or antipsychotics, so changes get caught early. |
| Vitamin D | Low vitamin D is extremely common and linked with low mood, fatigue, and poor sleep. Simple to correct when found. |
| Vitamin B12 and folate | Deficiencies cause fatigue, low mood, and cognitive fog. B12 also drops with long term metformin use, which matters for our weight management patients. |
| Ferritin and iron studies | Iron stores. Low iron causes fatigue, restless legs, and hair shedding, and it is common in women. Easy to miss without checking. |
| Magnesium | Involved in sleep quality, anxiety, and muscle tension. Often low and simple to address. |
| Total and free testosterone (men) | Low testosterone causes low energy, low mood, and reduced libido that overlap heavily with depression. Worth ruling out before calling it depression. |
| Estradiol, FSH, LH (women, when indicated) | Female hormone status. Helps sort out perimenopause, menopause, and cycle related mood changes from primary psychiatric conditions. |
| Prolactin (when indicated) | Certain antipsychotics raise prolactin, which can cause sexual side effects or unexpected milk discharge. We check it when symptoms suggest it. |
| Urine pregnancy test | Required before starting medications that must be avoided in pregnancy, including valproate and weight loss medications. |
| Urine drug screen | A baseline substance screen. It gives us an honest starting point, especially when controlled substances are being considered, and identifies substances that may be driving symptoms. |
The weight management lab panel
Weight is never just about willpower. These labs uncover the metabolic and hormonal factors driving weight gain, guide which treatments fit you, and measure progress objectively.
| Test | Why it matters for you |
|---|---|
| Hemoglobin A1c | Screens for prediabetes and diabetes. It guides whether a GLP-1 medication makes sense for you and becomes our main scoreboard for progress. |
| Fasting glucose and insulin | Identifies insulin resistance years before diabetes develops. Insulin resistance changes the nutrition plan and strengthens the case for medication support. |
| Fasting lipid panel | Excess weight raises cardiovascular risk. We track cholesterol and triglycerides improving as weight comes down, which is powerful motivation. |
| TSH | An underactive thyroid slows metabolism and causes weight gain directly. It must be ruled out before any weight plan begins. |
| Comprehensive metabolic panel | Screens for fatty liver, which is very common with excess weight, and confirms the kidneys are healthy for medication options. |
| Vitamin D | Deficiency is more common with obesity and tied to low mood and fatigue, both of which make weight loss harder. |
| Vitamin B12 | Metformin and reduced food intake can lower B12 over time. We watch it so energy and mood do not suffer silently. |
| Total and free testosterone (men) | Low testosterone and excess weight reinforce each other in both directions. Addressing hormones can unlock progress that diet alone could not. |
| PCOS labs (women, when indicated) | Free and total testosterone, DHEA S, LH and FSH, and prolactin. PCOS drives weight gain, insulin resistance, and mood symptoms together. Finding it changes the entire plan. |
| high sensitivity CRP (when indicated) | A marker of chronic inflammation, which tracks with both obesity and depression. Another objective number we can work on improving. |
| Urine pregnancy test | Weight loss medications are not used during pregnancy, so this is checked before starting. |
Monitoring while on medication
Starting a medication is the beginning of the conversation, not the end. Here is what we watch depending on the treatment.
Lithium
Lithium blood levels plus kidney function, thyroid, and calcium before starting and at regular intervals. This is exactly why the baseline panel matters so much for lithium patients.
Antipsychotic augmentation
Weight, blood pressure, fasting glucose or A1c, and lipids over time, with prolactin when indicated. Small metabolic shifts get addressed early.
Other mood stabilizers
Valproate and carbamazepine, if ever used, need liver function and blood count monitoring plus drug levels. Carbamazepine also needs sodium checks.
Stimulants
Blood pressure and heart rate at visits. An ECG is added when personal or family cardiac history suggests it.
Weight medications
A1c, weight trend, and kidney function on GLP-1 therapy, B12 with metformin, and review of gallbladder and pancreas symptoms at follow ups.
Why we recommend GeneSight testing
Psychiatric prescribing has a frustrating truth: the first medication tried is often not the right one. People can spend months cycling through drugs that never had a fair chance of working for their body. GeneSight exists to shorten that painful trial and error, and that is why we recommend it.
The problem it solves
Your genes control the liver enzymes that break down medications, mainly CYP2D6, CYP2C19, CYP2B6, and CYP1A2, the same pathways listed as “cleared by” on our medications page. People fall into categories from slow processors to fast processors. A standard dose is designed for the average person, so if you are not average, the standard dose can be wrong for you from day one.
Slow processors
Break down certain medications unusually slowly, so standard doses build up to higher blood levels. More side effects, more misery, and the medication gets blamed when the dose was the real problem. Example: a slow CYP2D6 processor taking paroxetine or aripiprazole.
Fast processors
Clear certain medications unusually quickly, so standard doses never reach effective levels. Weeks pass with no benefit and the medication gets blamed when the body simply cleared it too fast. Example: a fast processor taking venlafaxine.
GeneSight flags these mismatches before you live through them. It also tests HLA genes that predict rare but serious skin reactions to carbamazepine.
How it works
- A simple cheek swab. No blood draw and no needles. The swab is sent to the GeneSight laboratory.
- Your DNA is analyzed for the genes above, and the report sorts more than 60 mental health medications into three groups: use as directed, moderate interaction between your genes and the drug, or significant interaction between your genes and the drug.
- We review it together and use it to guide dosing choices and avoid medications your body is likely to mishandle.
Who benefits most
- Tried two or more medications without enough benefit. This is the classic situation where the test pays for itself.
- Struggled with side effects that felt out of proportion to the dose. Slow processing is a common hidden cause.
- Starting fresh and wanting data on your side from the beginning rather than guessing.
- Anxious about medications in general. Having objective information often makes the first step feel safer.
GeneSight does not predict which single medication will work best for you, and GeneSight’s own materials say so directly. It informs how your body handles medications. It does not replace your history, your prior experiences, or clinical judgment. We treat it as one powerful input among several, not a crystal ball.
Per GeneSight’s published cost information: 98% of patients pay $330 or less out of pocket. The typical out of pocket cost is $0 for patients on Medicare Part B, Medicare Advantage, and Medicaid. A reduced self pay option of $330 is available to everyone, including patients without insurance or whose insurance does not cover the test. Under the GeneSight Promise, if your cost would be more than $330 they contact you before processing the test, and an interest free payment plan is available if your cost is $100 or more. The test must be ordered by a clinician. You can read more at genesight.com.
How testing works here
Labs are ordered electronically and you visit a draw site convenient to you. The GeneSight swab is collected simply and shipped to their lab. Results come back to the practice and we review everything together at your follow up visit, in plain language, before any prescribing decisions are finalized.
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